Bethesda Baptist Church

Bethesda Baptist Church Incident Report Form

This form shall be used by staff and/or members that witness or become aware of an incident causing injury and/or damage to property. This report shall be submitted to a staff member as soon as possible.

Person completing this report first name:

Last Name

Reason for report:

Date of incident & time:

Place of incident:

Name(s) injured:

Age:

Injured party Address

Address 2

Country

City

State

Zip/Postal Code

Property damaged:

Briefly describe what happened:

Was an ambulance called:
Yes
No

Comment:

What action did you take or was taken at the time:

Were there any witnesses:
Yes
No

Names & Phone numbers of any witnesses:

Has the cause of the incident been removed:
Yes
No
N/A

Submit

Bethesda Baptist Church Incident Report Form

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